Enoxaparin

Enoxaparin

Class:
  • Low Molecular Weight Heparin (LMWH)
Actions:
  • Inactivate clotting factor Xa, blocking the conversion of prothrombin to thrombin
Indications:
  • Prevention of DVT following surgery or during prolonged bedrest
  • Treatment of DVT with or without pulmonary embolism
  • Unstable angina, NSTEMI, STEMI
Pharmacokinetics:
  • Peak: 3 – 5 hours
  • Half-Life: 3 – 6 hours
  • Duration:  12 hours
Adverse Effects:
  • Hemorrhage, thrombocytopenia, anemia
  • Hypersensitivity (rash, urticaria), fever, arthralgia, angioedema
  • Abnormal liver function tests
  • Neurological injury for persons undergoing spinal canal procedures (spinal puncture, epidural anesthesia)
Contraindications:
  • Thrombocytopenia (platelet count < 100,000) including idiopathic thrombocytopenic purpura (ITP)
  • Active bleeding disorders (GI bleeding, peptic ulcer)
  • Hemophilia
  • Hypersensitivity to heparin
  • Recent intracranial, intraspinal, or eye surgery
  • Use with caution in patients who are having lumbar puncture or regional anesthesia
  • Safety in pregnancy (category B) or children not established
Dosages & Routes:
  • Intravenous: (for ACS only) 30 mg IV  bolus followed by 1 mg/kg SQ BID for up to 8 days
  • Subcutaneous:  (for DVT and other uses) 30 mg SQ BID; (pulmonary embolism) 1 mg/kg SQ BID
Nursing Implications:
  • Drug Interactions:  1) Aspirin, NSAIDS, oral anticoagulants, and anti-platelet drugs may increase the risk of bleeding; 2) feverfew, ginkgo, ginger, garlic, and horse chestnut may increase the risk of bleeding; 3) Protamine sulfate is an antagonist to enoxaparin (1 mg protamine for every mg of enoxaparin).
  • Drug Incompatibilities: Primarily given SQ. 
  • Protamine sulfate is the antidote for enoxaparin.
  • Only routes of administration are IV or SQ (does not absorb PO; IM causes hematoma)
  • Risk of bleeding increases.  Screen patients for contraindications.
  • Monitor periodically CBC for blood counts.
  • Assess  urine and stool for signs of blood.
  • Monitor injection sites for signs of hematoma.
  • Apply direct pressure to venipuncture sites for longer durations (e.g., 3 minutes).
  • Low molecular weight heparin (e.g., enoxaparin) is preferred for unstable angina and NSTEMI over unfractionated heparin.

 

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 55). Salem, MA: AHA.

Deglin, J.H., & Vallerand, A.H. (2009). Heparins (low molecular weight).  In Davis' drug guide for nurses (11th ed., pp. 619-623).  Philadelphia: F.A. Davis.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 601-603).  St. Louis: Saunders Elsevier.

Scruth, E., & Haynes, A. (2010) Cardiovascular disorders.  In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., p. 450-451).  St. Louis: Mosby Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 593-595).  Upper Saddle River, NJ: Pearson Prentice Hall.

 

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